Healthcare Provider Details

I. General information

NPI: 1225749112
Provider Name (Legal Business Name): TARA STEELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MARION PIKE STE 1
COAL GROVE OH
45638-2958
US

IV. Provider business mailing address

323 MARION PIKE STE 1
COAL GROVE OH
45638-2958
US

V. Phone/Fax

Practice location:
  • Phone: 740-237-4981
  • Fax:
Mailing address:
  • Phone: 740-237-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2022
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberQMHS
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number193232
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: